黑料网 Radiology Coding Source鈩� Nov-Dec 2007
The Centers for Medicare & Medicaid Services (CMS) recently implemented a new system of edits which cap the number of services payable on a specific date. Initially termed Medically Unbelievable Edits, CMS has renamed these Medically Unlikely Edits (MUEs). Although confidentiality restrictions imposed by CMS preclude the 黑料网 from disclosing details, the 黑料网 is committed to ensuring that these edits do not impede the delivery of good medical care to Medicare beneficiaries.
The 黑料网 is interested in learning how MUE edits are being implemented locally and nationally. In addition, the 黑料网 is interested in better understanding the impact on radiology practices and, therefore, would encourage practices to forward information to the College regarding specific day of service limitation denials. If you identify payment denials based on MUEs, this information will be most useful to us.
Although the 黑料网 is prohibited by CMS from disclosing confidential material it received during the MUE process, no such restriction exists for information received from 黑料网 members. As such, this information will be extremely important to radiology practices across the country, and the 黑料网 hopes to use this knowledge to identify inappropriate edits which unnecessarily restrict care.
The 黑料网 is working with the American Medical Association and many other specialty societies to ensure that these restrictions on health care payment are subject to the same public disclosure and scrutiny as all other restrictions placed upon public health funds. Your assistance will greatly help us in this mission.
If you are familiar with MUE edits impacting your practice, please submit the following via email to Gloria Garcia at ggarcia@acr.org. For your reference, a commonly used “remark code” utilized by Medicare to identify an MUE claim denial is “N362 The number of Days or Units of Service exceeds our acceptable maximum.”
State:
Carrier:
CPT code:
Utilization limit:
Statement of denial:
The 黑料网 is interested in learning how MUE edits are being implemented locally and nationally. In addition, the 黑料网 is interested in better understanding the impact on radiology practices and, therefore, would encourage practices to forward information to the College regarding specific day of service limitation denials. If you identify payment denials based on MUEs, this information will be most useful to us.
Although the 黑料网 is prohibited by CMS from disclosing confidential material it received during the MUE process, no such restriction exists for information received from 黑料网 members. As such, this information will be extremely important to radiology practices across the country, and the 黑料网 hopes to use this knowledge to identify inappropriate edits which unnecessarily restrict care.
The 黑料网 is working with the American Medical Association and many other specialty societies to ensure that these restrictions on health care payment are subject to the same public disclosure and scrutiny as all other restrictions placed upon public health funds. Your assistance will greatly help us in this mission.
If you are familiar with MUE edits impacting your practice, please submit the following via email to Gloria Garcia at ggarcia@acr.org. For your reference, a commonly used “remark code” utilized by Medicare to identify an MUE claim denial is “N362 The number of Days or Units of Service exceeds our acceptable maximum.”
State:
Carrier:
CPT code:
Utilization limit:
Statement of denial: